Joseph M. Zulu - Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia
Maligzani P. Chavula - Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia
Adam Silumbwe - Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia
Margarate N. Munakampe - Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia
Chama Mulubwa - Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia
Wanga Zulu - The Ministry of Health, Lusaka, Zambia
Charles Michelo - Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia
Helen Schneider - School of Public Health, University of the Western Cape, Cape Town, South Africa
Uta Lehmann - School of Public Health, University of the Western Cape, Cape Town, South Africa

There have been increased calls for low- and middle-income countries to develop community health systems (CHS) policies or strategies. However, emerging global guidance brackets the inherent complexity and contestation of policy development at the country level. This is explored through the case of Zambia’s ۵-year Community Health Strategy (CH Strategy), formulated in ۲۰۱۷ and then summarily withdrawn and reissued two years later, with largely similar content. This paper examines the events, actors, and contexts behind this abrupt change in the Strategy, through an analysis of documentary sources and interviews with ۲۱ stakeholders involved in the policy process. We describe an environment of contestation, characterised by numerous international partners weighing in on the CH Strategy, interfacing with shifting loci of responsibility for the CHS in the Ministry of Health (MoH). Despite the rhetoric of participation, providers and communities played no part in the policy process. These dynamics created the conditions for the abrupt change in strategy, illustrating the inherently fraught and political nature of policy development on the CHS in many countries. Going forward, we conclude that paying attention to processes of CHS policy development, and in particular the interaction between events, actors, and contexts, is as important as ensuring meaningful policy content.

Community Health Strategy, Community Health System, Politics, policy development